Healthcare Provider Details

I. General information

NPI: 1851596100
Provider Name (Legal Business Name): ANNA MARIE DORELIEN LPN, MSED, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1887 RICHMOND AVE 1887 RICHMOND AVE
STATEN ISLAND NY
10314
US

IV. Provider business mailing address

1887 RICHMOND AVE
STATEN ISLAND NY
10314
US

V. Phone/Fax

Practice location:
  • Phone: 718-698-1300
  • Fax: 917-667-8601
Mailing address:
  • Phone: 718-698-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number2314371
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number708643
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-11-9021
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: